What are the discharge instructions for a patient who received a prophylactic dose of doxycycline (doxycycline) in the emergency department after a tick bite?

Discharge Instructions After Prophylactic Doxycycline for Tick Bite

After receiving prophylactic doxycycline for a tick bite, the patient should be instructed to monitor for symptoms of Lyme disease for 30 days, particularly watching for the development of an expanding skin lesion (erythema migrans) at the bite site or any flu-like symptoms, and to seek immediate medical attention if these occur. 1

Monitoring for Signs and Symptoms

• Monitor the tick bite site for 30 days for development of an expanding red rash (erythema migrans), which may appear as a "bull's-eye" pattern and is the hallmark sign of early Lyme disease 1
• Watch for flu-like symptoms including fever, chills, fatigue, body aches, headache, and swollen lymph nodes 1
• Understand that while the single dose of doxycycline reduces the risk of developing Lyme disease by approximately 87%, it does not provide 100% protection 2
• Be aware that the prophylactic dose is most effective when given within 72 hours of tick removal, and its efficacy decreases significantly after that window 3

Medication Information

• No additional doses of doxycycline are required for prophylaxis - a single 200mg dose is the complete prophylactic regimen 1
• Common side effects of doxycycline may include nausea (15.4%), vomiting (5.8%), and other gastrointestinal symptoms 2
• Avoid excessive sunlight or artificial ultraviolet light while the medication remains in your system (approximately 2-3 days) due to risk of photosensitivity 4
• Drink fluids liberally to reduce the risk of esophageal irritation 4

Prevention of Future Tick Bites

• Use protective clothing and EPA-registered tick repellents (DEET, picaridin, IR3535, oil of lemon eucalyptus, PMD, 2-undecanone, or permethrin) when in tick-endemic areas 1, 5
• Perform daily full-body tick checks when in tick-endemic areas 1
• Remove attached ticks promptly using fine-tipped tweezers, grasping the tick as close to the skin surface as possible and pulling upward with steady pressure 1
• Do not burn ticks or apply noxious chemicals to remove them 1

When to Seek Medical Attention

• Return immediately if you develop an expanding rash at the bite site or anywhere else on your body 1
• Seek medical care if you develop fever, headache, fatigue, muscle/joint pain, or other concerning symptoms within 30 days of the tick bite 1
• Be aware that symptoms of other tick-borne diseases (such as anaplasmosis or babesiosis) may still develop despite doxycycline prophylaxis 1

Important Considerations

• The single dose of doxycycline is most effective when the tick was attached for ≥36 hours, was an Ixodes species (blacklegged tick), and was removed in a highly endemic area 1
• The risk of developing Lyme disease after a tick bite is higher when the tick is a nymphal stage and is partially engorged with blood (9.9% risk) compared to adult female ticks or unfed nymphal ticks 2
• Testing for Lyme disease is not recommended in asymptomatic individuals following a tick bite, even after receiving prophylaxis 1